許智凱、張廷瑞、陳世亮

台南市立醫院 泌尿科

Experience of PCNL with One Stage Tract Dilation Using Bard X-Force ^® N30 Balloon Catheter in Tainan Municipal Hospital

Chih-Kai Hsu, Ting-Jui Chang, Shih-Liang Chen

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

 

Purpose: Percutaneous nephrolithotomy(PCNL) had replaced open nephrolithotomty as a standard treatment for large renal stones and staghorn stones for decades. But the complications during this operation still bothering surgeons, such as bleeding and failure of nephrostomy tract. In the traditional fashion, this procedure was separated into two stages, the access tract was created by a radiologist at their department, and then the patient was transported to operation room. Urologists completed the tract dilating and stone was retrieved. The access tract sometimes wound lost during the transportation, thus one stage puncture and dilatation method can prevent this embarrassing situation. The traditional dilating method will use sequential dilators, directly creating the tract to the required size, or use a balloon dilator after a 10~12Fr tract was created. But lost tract and massive bleeding still problems when the sequential dilators was used. We reported our experience of PCNL with the new designed balloon dilator, that need no more sequential dilators with one stage method.

Materials and Methods: Patients with renal stones larger than 2cm, or failed to previous ESWL were included. Ureteral catheter was inserted first for artificial hydronephrosis. Patient was positioned at prone position and ultrasound or fluoroscopic guided renal puncture was made by a 18G Chiba needle. Bard N30 balloon dilator was introduced directly after safety guidewire was secured. The tract was dilated by the balloon at 10 atm for 5 minutes, Amplatz sheath inserted and stone retrieval was accomplished by pneumatic lithotripter and grasping forceps. Peri-operative event was recorded and the hemoglobin and hematocrit change was observed. Stone free was defined as no visible stone by KUB.

Results: From Apr. 2015 to Mar. 2016, total 18 patients received PCNL with Bard N30 balloon dilator. Age: 54.4(35~74)y/o. Mean stone size: 34.9(11~57)mm, included 2 diverticular stones. All procedure was completed in one stage method with total operation time: 138(100~210)min. None of all patients had experienced massive bleeding or needed blood transfusion perioperatively. Hgb changed from 14.2 to 12.9, whereas Hct from 41.7 to 38.2 on next day, with no clinical significant. The mean hospital stay is 4.9 days. 3(16.7%) cases have infection and fever after PCNL with hospital stay up to 8 days . No delayed bleeding or renal function deterioration noted at the follow up.

Conclusion: In our series, one stage tract balloon dilation technique is reliable and time saving method for PCNL tract creation. But equipment like fluoroscopy and ultrasound guiding system are indispensable. More cases are needed for compares to other tract creation methods.